Basic Information
| Provider Information | |||||||||
| NPI: | 1114126653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SEJAL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 WHITE PLAINS RD | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | TARRYTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105915837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146319020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 112 FRANKLIN CORNER RD | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086482104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098961494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2007 | ||||||||
| LastUpdateDate: | 07/14/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01162700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 40QA01162700 | 01 | NJ | PHYSICAL THERAPIST LICENS | OTHER |